Predicting Intra-Abdominal Adhesions in Repeat Cesarean Sections: Scar Tissue Characteristics, Striae Gravidarum, and Corset Use

Background: This study evaluated whether abdominal scar tissue characteristics, duration of corset use, and striae gravidarum (SG) density are associated with the severity of intra-abdominal adhesions (IAA) in repeat cesarean sections (CS). Methods: This study prospectively recruited 800 women in their third trimester of pregnancy who were admitted to our clinic for repeat CS. Data was collected on the number of previous CS, history of corset use after prior CS, and demographic characteristics. Abdominal scar characteristics were visually classified by surface appearance (dimpled, smooth, or raised) and pigmentation status (hyperpigmented or normal). SG density was determined using Davey’s scoring system. IAA were classified intraoperatively according to the Nair classification system. Results: Among the 800 participants, 220 (27.5%) had no IAA, 296 (37.0%) had filmy adhesions, 136 (17.0%) had more than two dense adhesions, 124 (15.5%) had very dense adhesions, and 24 (3.0%) had a frozen pelvis. Univariate analysis showed significant associations between IAA scores and maternal age, height, body mass index (BMI) gravida, parity, and the number of previous CS (p < 0.001 for all). In multivariable analysis, the number of previous CS remained significantly associated with IAA scores. For each additional previous CS, the odds of developing dense adhesions increased nearly threefold (odds ratios [OR] = 2.85, 95% confidence intervals [CI]: 2.10–3.88, p < 0.001). In contrast, no significant associations were found between IAA scores and scar tissue characteristics, scar tissue pigmentation, SG density, history of corset use, or smoking (p > 0.05). Conclusions: Preoperative evaluation of scar tissue characteristics, SG density, and history of corset use did not predict the presence or severity of IAA before elective CS. However, a significant association was observed between the number of previous CS and IAA. No significant association was observed between smoking and IAA.